The Series

Afflictions: Culture & Mental Illness in Indonesia is a documentary film series that examines the lives of severely mentally ill people living on the Indonesian islands of Bali and Java. Afflictions is based on more than a decade of clinical ethnographic research conducted by documentary filmmaker and anthropologist Dr. Robert Lemelson.

Each of the six films—Memory of My Face, The Bird Dancer, Family Victim, Ritual Burdens, Shadows and Illuminations and Kites & Monsters— tells the story of the diagnosis, care and treatment an Indonesian suffering from a mental disorder and looks at the impact of culture, family and community on the course of their illness. Themes emerge with universal impact: how family members treat the mentally ill shapes outcomes, both positive and negative; culture has the power to protect and buffer the mentally ill or exacerbate their condition; to understand the experience of the mentally ill, it is essential to understand their cultural universe and values; and finally, pharmaceutical treatment can be effective or unsuccessful.

Volume 1: Psychotic Disorders

Volume 2: Neuropsychiatric Disorders

“Shadows and Illuminations” (2010) A Balinese rice farmer haunted by the spirit world (35 min)

The film follows an older Balinese man, Nyoman Kereta, as he struggles with the intrusion of spirits into his consciousness. Kereta says he has been living in two worlds, the world of his family and community and the world of the spirits, for the past 40 years. His experiences skirt the borders of cultural and spiritual norms, simultaneously manifesting and exceeding Balinese beliefs about the supernatural world and the possibilities for human interaction with it.

Kereta’s reported experiences seem credible or explicable to some, bizarre and extraordinary to others, enigmatic or doubtful to his wife, and the sign of major mental illness to his psychiatrist. The film documents his painful history of trauma, loss and poisoning, and draws on his other family member’s interpretations of how to understand his struggles and distress. Central questions of how to interpret his experiences, and what role a schizophrenia diagnosis entails are explored.

The film focuses on Gusti Ayu Suartini, a young Balinese woman living with Tourette’s syndrome. Members of Gusti’s small rural community, who do not recognize her illness as a medical disorder, regard her with scorn or pity. Mired in loneliness, Gusti begins to question the meaningfulness of her existence after treatment by western and traditional practitioners fails.

The film, which follows her slow, painful, and courageous effort to create an independent life for herself outside her village, addresses the profound impact of family and community’s acceptance or rejection on the lifecourse of persons living with a neuropsychiatric disorder. The Bird Dancer focuses on the social stigma of neuropsychiatric disorder and the human suffering it entails.

“Memory of My Face” (2011) An Indonesian perspective on madness in a globalizing world (22 min)

The film focuses on Bambang Rudjito, a university-educated Indonesian man in his late thirties diagnosed with schizoaffective disorder. It explores the “globalized” features of Bambang’s illness and recovery narrative — western psychiatric diagnostics and pharmaceuticals, work opportunities in a rapidly changing urban environment, participation in an interfaith religious community, and his family’s understanding and acceptance of what Bambang describes as a “mental disability.”

But it also considers aspects of Bambang’s more complex, historically and politically shaded narrative, giving language and a deeper substance to his illness experience. Memory of My Face illustrates how the residues of colonialism and the pervasive influence of globalization affect the subjective experience of mental illness.

“Family Victim” (2010) The ‘bad coconut’ of a Javanese family (38 min)

Estu Wardhani is a young Javanese man and has struggled for most of his life to achieve a sense of competency and inclusion in his familial and social world. The second youngest of eight children born to an upper-class family living in the rural region of Gunung Kidul in Cental Java, Estu has been ‘different’ ever since he was a young boy. Estu’s actions, and their disorienting power, cannot be understood outside of the cultural and social context within which they have taken shape nor can they be considered apart from the disruptive and painful effects they have on his family.

Estu’s problems are interpreted as ‘psychopathy’ by a psychiatrist, spirit possession by local healers, and as dimangakan or ‘spoiled’ by his family. Estu himself desires to be a ‘big man’, and he feels misunderstood and disrespected by his family. His case involves not only his own troubling symptoms, but the striking and extensive interpretive work his family, healers and community engages in while trying to understand Estu’s personality and behavior. This film explores the multiple ways the family interprets such dilemmas, and his tribulations and finally transformations as he matures into culturally defined adulthood.

The film focuses on Ni Ketut Kasih who has lived her whole life surrounded by the complex rhythms of the Balinese ritual calendar. Here, participation in ritual events is both a spiritual mandate and social obligation for women who spend countless hours crafting offerings. Ni Ketut’s masterful hand has contributed to her status as a highly respected ceremonial leader. However, the pressures of ritual requirements often overwhelm her, crowding her mind with memories of her difficult childhood during Indonesia’s war for independence.

This may trigger Ketut’s bi-polar disorder episodes, for which she has been hospitalized over 35 times. Ni Ketut’s case reveals the binding associations that may make certain burdens unbearable as cultural obligations, traumatic historical events, and personal experience overlap in unique schemas of stress that trigger cyclical episodes of mental illness. Ritual Burdens questions how communal spiritual obligations may be folded into personal schemas of stress to trigger episodes of mental illness.

The film focuses on a growing boy, Wayan Yoga, and is not so much about illness as it is an exploration of the protective aspects of culture that may guide developmental neuropsychiatric processes. At six years old, Wayan Yoga is an energetic boy who flies kites and is obsessed with the monsters of Balinese mythology. He also has various tics, which move his parents to seek treatment. At twenty, he is a young man planning his career as a chef and an expressive Balinese dancer.

Ultimately, Wayan Yoga’s tics are insignificant to his evolving sense of self-compared to the saturation of symbols, images, and narratives of his culture. While Wayan must learn to negotiate the kinds of movements, interests, and goals that are culturally appropriate, the protective buffer of his family guides him successfully into normative Balinese adulthood.

The film series is unique is at is the first film series on mental illness in the developing world and integrates over 13 years of ethnographic research and footage. Some of the themes that emerge are the way in which family members treat the mentally ill shapes positive and negative outcomes, how culture has the power to protect and buffer the mentally ill or exacerbate their condition, how pharmaceutical treatment can be effective and unsuccessful, and that to understand the experience of the mentally ill, it is essential to understand their cultural context and values.

Filmmakers

Elemental Productions

Production Company

Ele­men­tal Pro­duc­tions is a Los-Angeles based ethno­graphic doc­u­men­tary film com­pany ded­i­cated to the pro­duc­tion of films focus­ing on the rela­tion­ship between cul­ture, psy­chol­ogy, and per­sonal expe­ri­ence. Ele­men­tal Pro­duc­tions was founded in 2007 by anthro­pol­o­gist Robert Lemel­son and evolved out of field­work gathered in Indonesia since 1997.

Afflictions: Culture & Mental Illness in Indonesia Film Series

Robert Lemelson

Director & Producer

Robert Lemelson is a cultural anthropologist, ethnographic filmmaker and philanthropist. Lemelson received his M.A. from the University of Chicago and Ph.D. from the Department of Anthropology at UCLA. Lemelson’s area of specialty is transcultural psychiatry; Southeast Asian Studies, particularly Indonesia; and psychological and medical anthropology. He currently is a research anthropologist in the Semel Institute of Neuroscience UCLA, and an adjunct professor of Anthropology at UCLA.

Afflictions: Culture & Mental Illness in Indonesia Film Series

Alessandra Pasquino

Producer

Alessandra Pasquino is a filmmaker and producer of documentaries, commercials, and special projects. She has collaborated with many artists and celebrities including: Oliver Stone, Wayne Wang, Klaus Kinski, Gregory Colbert, Leonardo Di Caprio, Pietro Scalia and Matthew Rolston. She is currently developing documentary projects both with Elemental Productions and independently.

Afflictions: Culture & Mental Illness in Indonesia Film Series

Wing Ko

Director of Photography & Editor

Wing Ko has collaborated with a who’s who of modern artists, musicians and filmmakers. He worked with Spike Jonze on several music videos and edited the pilot for MTV’s “Jackass.” Wing helped create more than 80 music videos for Nine Inch Nails, Soundgarden, Public Enemy and other top bands of the time. For more than 15 years he has traveled around the world and crewed skateboard videos.

Afflictions: Culture & Mental Illness in Indonesia Film Series

Dag Yngvesson

Director of Photography

Dag Yngvesson was the cinematographer on “Stoked: the Rise of Gator,” a documentary about the rise and fall of skateboard legend Mark “Gator” Ragowski and wrote, produced and edited “Rated X: A Journey through Porn,” about the Los Angeles porn industry. Yngvesson studied film and anthropology at Pitzer and Hampshire Colleges, where he made his first films: “The Kaos Company,” a documentary on squatters in Gothenburg, Sweden, and “Making Skateboards in New Russia,” about skateboarder/ entrepreneurs in St. Petersburg after the fall of communism.

Afflictions: Culture & Mental Illness in Indonesia Film Series

Pietro Scalia

Consulting Editor

Born in Sicily, Pietro Scalia won two Academy Awards for Best Editing including JFK by Oliver Stone and Black Hawk Down by Ridley Scott. His other editing credits are Body of Lies, American Gangster, Memoirs of a Geisha, Hannibal, Good Will Hunting, The Quick and The Dead, Stealing Beauty, Little Buddha and many others.

Afflictions: Culture & Mental Illness in Indonesia Film Series

Sandra Angeline

Editor

Sandra Angeline edited “Memory of My Face” and “Family Victim” for Elemental Productions. Angeline’s credits as editor also include “Broken,” “Extreme Makeover: Home Edition,” and other shows for ABC, Travel Channel and The Style Network. She has worked as an assistant editor on the television series “Wilfred” and the feature films “Smart Ass” and “The Odd Life of Timothy Green.” Angeline studied film at CUNY Hunter College, New York and New York Film Academy.

Afflictions: Culture & Mental Illness in Indonesia Film Series

Herbert Bennett

Editor

Herbert Bennett edited “The Bird Dancer” and “Ritual Burdens” for Elemental Productions. He is a two-time Emmy Award winning editor and was instrumental in the postproduction of three Academy Award-nominated documentary films: “Weather Underground,” “Berkeley in the 60’s,” and “Promises.” Herbert lives in Los Angeles, CA, where he edits films and new media.

Afflictions: Culture & Mental Illness in Indonesia Film Series

Mike Mallen

Editor & Graphic Design

Mike Mallen designed the graphics for “Afflictions: Culture & Mental Illness in Indonesia” and edited “Ritual Burdens.” He has been an editor, graphic designer and visual effects artist for the past nine years, working in a wide range of genres including reality television, documentaries and scripted films.

Afflictions: Culture & Mental Illness in Indonesia Film Series

Chisako Yokoyama

Editor

Chisako Yokoyama has worked as an editor and assistant editor on studio motion pictures, independent features and narrative and documentary films. Her credits as editor include the English and Japanese language independent films “Saki,” “Takamine” and “Goemon” and as first assistant editor, “American Gangster,” “Memoirs of a Geisha,” “Black Hawk Down” and “Good Will Hunting.”

Afflictions: Culture & Mental Illness in Indonesia Film Series

Richard Henderson

Music Editor

Henderson’s writing on ethnomusicology, film music and avant-pop still appears in The Wire (U.K.) and his reportage has previously graced the pages of Billboard, The Beat, Soma, Escape, LA Weekly and Murder Dog; work on four film scores as assistant to his one-time band mate, the justly lauded solo artist, producer and film composer Michael Brook, led to music editing and music supervision for films such as Borat, The Life Aquatic and Into The Wild (the latter earning Henderson the 2007 Golden Reel Award for Music Editing in Feature Films).

Afflictions: Culture & Mental Illness in Indonesia Film Series

Malcolm Cross

Music Composer

Malcolm Cross BSc Mus. Studied music performance and composition in London at the Guildhall School of Music and Drama, additional Post Graduate studies in Jazz and Studio Music. Malcolm has been a professional composer for film, television and stage since 1996. His original film scores include ‘Insomniac Obsession’ (directed by Paul Cameron Carter/PS Films) and ‘Oh Saigon’, a feature-length documentary for Sundance Channel directed by Doan Hoang, ‘I Dream of Dog’ an independent comedy short directed by Jessica Rice and ‘The Grey’, a supernatural thriller directed by Norman Trotter IV.

Afflictions: Culture & Mental Illness in Indonesia Film Series

Ninik Supartini

Field Supervisor

Ninik Supartini assisted Dr. Lemelson in two research projects about community mental health in Java and Bali. Since 2006, Supartini has served as a mental health and psychosocial consultant for international humanitarian organizations working in post-disaster and conflict areas in Indonesia and Myanmar. Supartini studied English teaching as an undergraduate at the Yogyakarta Teacher Training Institute and lectured in English for more than ten years before turning her interests to community mental health. In 2004, she returned to school at Gadjah Mada University to earn her Masters Degree in Developmental Psychology. Supartini was honored with a Donald J. Cohen Fellowship in 2006 and East West Center Fellowships in 2006 and 2007.

Afflictions: Culture & Mental Illness in Indonesia Film Series

Mahar Agusno

Consulting Psychiatrist

Mahar Agusno is head of the Psychiatric Department at Sardjito General Hospital and head of the Study Program, Department of Psychiatry, Faculty of Medicine, Gadjah Mada University. He received his M.D. & psychiatric training from Faculty of Medicine, Gadjah Mada University. Agusno’s long-term service at the community and mental hospital has contributed significantly to his interest in community and cultural psychiatry. After he finished his mandatory service in a mental hospital in Borneo in 1997, Agusno returned to the Department of Psychiatry, Gadjah Mada University to serve as a lecturer. Simultaneously, he worked at the university’s teaching hospital, Sardjito General Hospital. In 2002, Agusno was awarded a Freeman Fellowship to study medical anthropology at Harvard Medical Schoo

Afflictions: Culture & Mental Illness in Indonesia Film Series

Director’s Statement

One hundred-fifty million people suffer from different types of mental illness in the developing world, where psychiatric treatment is often limited or non-existent. With such daunting statistics, one would expect their recovery rate and outcomes to be deficient. But, the World Health Organization, in a landmark, decades-long research project, found that the mentally ill living in non-industrialized nations actually fare better than their industrialized counterparts where biological approaches to mental illness prevail. On a population level, the mentally ill—including schizophrenics–return to their homes and their jobs more quickly, are hospitalized less frequently and experience less severe symptoms, overall.

In 1996, armed with a Fulbright scholarship, I went to Iive in Bali and Java, to research the circumstances behind these startling findings, along with the more general question of the relationship between culture and mental illness. At that time, I interviewed many patients. As an anthropologist, I was not only interested in their diagnosis, illness and treatment, but also in their goals and values, in how their illness impacted their self-perception and self-esteem, and how they were regarded and understood by their family and community.

In subsequent years, I returned to Indonesia many times to film mentally ill men, women and children (forming long-term relationships), to record their struggles and defeats and moments of happiness and transcendence. Afflictions: Culture & Mental Illness in Indonesia, the first film series on the lives of the mentally ill in the developing world, was born out of this footage.

“Afflictions” evolved into six short films. With the probing and detailed eye of the video camera, the films look at an equal number of Indonesians who suffer from schizophrenia, Tourette’s syndrome and anti-social personality disorder. The narratives are at turns informative, disturbing and even heartwarming.

As the stories unfold, it becomes clear that it is neither their psychiatric diagnosis nor their illness, per se, that is the most troubling to the mentally ill. Rather, it is the response of their family and community to their condition and the depth of their struggle to forge identities that they believe to be valued and valuable.

The “Afflictions” films shine a light on societal issues impacting the experiences—the suffering and the wellbeing–of the mentally ill, some specific to the Indonesian culture and others with global application. Balinese religious symbology, Dutch colonial occupation and Indonesian historical events play a role in the their stories. At the same time, universal concepts rise to the surface: home placement can be more beneficial than institutional care; urban living impacts disease onset and outcomes; and treatment modalities that integrate psychiatric and outpatient treatment can be the most effective.

In the end, it is my hope that the findings clarified and made accessible in “Afflictions” help shape the care and treatment of the mentally ill in Indonesia, in other developing nations and around the world.

FAQ

What inspired you to create the “Afflictions: Culture & Mental Illness in Indonesia” film series?

According to the seminal studies conducted by the World Health Organization (WHO), the prognosis for patients diagnosed with severe mental illness is significantly better in developing nations than industrialized nations. On a population basis, those in the developing world experience less severe symptoms, fewer subsequent episodes and greater job retention than their western counterparts. This finding is counterintuitive for many reasons, including the greater monetary investment by the west in research and treatment and the economic and cultural barriers to new modalities in psychiatric care in developing nations.

How does “Afflictions” break new ground?

“Afflictions” is the first film series on mental illness in the developing world. It is also the first film series to look at the long-term care and treatment of mentally patients in a developing nation and to illustrate the likely reasons for their outcomes.

What was the filmmaking process?

As an ethnographic filmmaker, I began the process with a strong vision of what I wanted to investigate, but without pre-conceived notions of the outcomes. I initially interviewed more than 100 potential subjects, culled from clinics, village surveys and personal referrals, and selected six diverse, yet representative cases on which to focus. After lots of hours in the editorial bay, as the research and the overall narrative fell into place, I worked with my crew to arrange additional interviews and activities to fill out the stories.

How did you build trust with the films’ characters?

In addition to my work as an anthropologist, I am a trained clinical psychologist and spent several years interviewing and assessing the mentally ill and providing psychotherapy. I learned techniques that I have brought to conducting interviews as a documentarian, including: a nonjudgmental and supportive attitude; a proclivity for remaining silent—especially during long, uncomfortable pauses—to allow my subjects to work through their anxiety and discomfort; and most importantly, the patience to address issues multiple times until the truth becomes apparent to the camera.

What was the most challenging “Affliction” film to direct?

“Family Victim,” which looks at the life of a troubled and rebellious young man, was perhaps the most challenging film to direct because its subject–Estu Wardhani–is the son of professional colleagues. It was difficult to depict the truth of Estu’s story while at the same time remaining sensitive to his family’s need for privacy and to their desire to protect their reputation.

Why did you choose film rather than the written word as your medium?

Although longitudinal studies have been written about mental and neuropsychiatric illness in developing nations, there haven’t been any films about the topic. Because of the all-encompassing nature of cinematic language, many of the issues central to achieving better patient outcomes can be expressed more succinctly and directly using a visual medium. In addition, cinema allows audiences to directly and emotionally understand the complex factors that impact the lives of the mentally ill, while introducing a different and unfamiliar cultural setting in which these stories unfold.

Why is “Afflictions” timely and relevant?

One in 17 Americans live with a serious mental illness and 450 million, worldwide, suffer from a mental or behavioral disorder. It’s a serious global problem that has been supplanted, on the one hand, by concerns about HIV/AIDs, TB and malaria and, on the other, funding shortages. While definitions and diagnoses vary from nation to nation, mental illness has important cross-cultural similarities.

“Afflictions” uses the medium of film to emotionally move mental health policymakers and practitioners, patients and their families. It strives to educate them about other points of view and to inform them about what they can do to improve outcomes for the mentally ill from all socioeconomic backgrounds.

Why is “Afflictions” pertinent to the highly anticipated DSM update?

In the west, serious mental illness is increasingly viewed through the singular lens of biomedicine, as demonstrated by the contents of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). The APA is currently making final preparations to release, in May 2013, the manual’s first major update in nearly two decades.

“Afflictions,” in contrast, is inspired by Harvard psychiatrist and medical anthropologist Arthur Kleinman’s groundbreaking work about the importance of bringing an ethnographic perspective to psychiatric research and practice. The “Affliction” films illustrate the complexity of mental illness, and depict how history, globalization and urban living impact its course. Most importantly, “Afflictions” elucidates how families and society understand, label and treat mental illness makes an enormous difference in patient outcome.

Why did Dr. Lemelson choose Indonesia as the location?

Indonesia is a psycho-culturally fascinating nation that sits at the confluence of traditional and modern ways of living. It has attracted many researchers over the years and, as a result, offers a strong foundation for ethnographic study. Indonesia is also an emblematic developing nation, and its research findings are applicable to other developing nations.

“Afflictions” is Dr. Lemelson’s second body of work in Indonesia. The first, the feature documentary “40 Years of Silence: An Indonesian Tragedy,” examines the impact, on four families, of General Suharto’s mass killing of between 500,000 to 1,000,000 suspected communists in 1965-66.

How can I see the “Afflictions” film series?

“Afflictions: Culture & Mental Illness in Indonesia” is available for purchase by individual viewers at der.org, amazon.com or at elementalproductions.org. The film is available for educational and institutional purchase at der.org.

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